Without a home run antiviral for Covid-19, Francis S. Collins wants a big push to develop a treatment from scratch to prepare for future pandemics or a new coronavirus.
That work will likely take two to three years and definitely require more funding, the longtime director of the National Institutes of Health acknowledged. By then the nation should be long past herd immunity in the present crisis, which could happen this fall if 70% to 85% of the U.S. population receives their vaccines. But even with the unprecedented success of vaccine development for Covid-19—much of which built on decades of basic research funded at the NIH—Collins said the biomedical research enterprise has a lot of work ahead.
“We must not lose this opportunity. Even as we hope we’re going to get past the worst of SARS-CoV-2, we’ve got to keep this momentum going. There will be other pandemics. And some of them may very well be coronaviruses.
When President Joe Biden announced he was reappointing Collins to lead the nation’s biomedical research programs, he made the physician-geneticist the only NIH director to be tapped by three different presidents for the role. Collins, who was first sworn in on Aug. 17, 2009, will also be one of the longest-serving NIH directors of all time. The longest, James A. Shannon, held the NIH director spot from 1955 to 1968, before the position required a presidential nomination starting in 1971.
Collins spoke to Bloomberg Law on Jan. 22—which he observed was the third day working under his third administration—about NIH priorities in the Biden administration, both for the Covid-19 response and beyond.
“I’m obviously honored and privileged to be able to continue in this role because I believe so much in what NIH can do and has been doing to address the world’s biomedical problems, and especially in the midst of Covid‑19,” Collins said. “We have a lot of work we’re in the middle of, and my opportunity now to try to be a source of continuity is, I hope, going to be helpful.”
‘The President-elect Wants to Talk to You’
The decision to keep Collins isn’t surprising, as he’s one of the few bipartisan political appointees in a very partisan environment. President
With Biden’s election, there were murmurings he would retain Collins, “but it wasn’t entirely clear whether that was coming from the top,” the NIH director recalled. Collins submitted his resignation as all political appointees must do.
Then about a week before the inauguration, the call came.
“I got a call from somebody who said that the president-elect wants to talk to you. And there he was—
“He had a lot of confidence in what I was doing and what I could do. And so, he was saying, ‘Please, we want you to stay on the team. We need you to be part of the solution here. Will you agree to be carried over?’ And, of course, I said yes.”
“Of course, Tony Fauci is very much in the center of what is being done about Covid. And Tony and I do speak nowadays several times a day on making sure to make the most of this opportunity for science to lead the effort,” he said, referring to the director of the NIH’s National Institute of Allergy and Infectious Diseases who’s Biden’s chief medical adviser on Covid-19.
Their priorities include more work on vaccines, new therapeutics, and better tests, Collins said. “We’ve still got a lot of work to do,” he said.
New Vaccine, Testing Projects
On the vaccine front, the NIH is starting a program to understand whether virus mutations lessen how well vaccines and monoclonal antibodies work. They’re also working on a testing pilot project with the Centers for Disease Control and Prevention that would essentially flood a community with free, at home testing to see if it changes behaviors.
“We are still not in the place where we need to be in terms of knowing what’s the right approach to testing to get schools reopened, to make it safe for everybody to come back to the workplace, to open up restaurants and other places that people would like to go, which is just not safe right now,” Collins said.
Collins said he hopes the testing pilot program will be up and running in a few weeks.
On the therapeutic front, Collins said the agency has worked to identify the most promising ideas among hundreds and hundreds to put them into well-designed, rigorous, and faster, protocol‑driven clinical trials. There have been some successes, including recent findings that full-dose blood thinners reduced the need for life support and led to better outcomes for hospitalized Covid-19 patients.
“We have not known that. Most patients have been getting low-dose, which is considered to be sort of now standard of care,” Collins said because providers have been concerned the high-dose version could cause more side effects like bleeding. “This study showed actually it caused no more side effects, and it clearly benefited in terms of keeping people from ending up on the ventilator.”
They’re also moving forward with more monoclonal antibody therapeutics, Collins said. But long term there’s a need to develop antivirals that are specific to the coronavirus.
“We hoped that there might be some that had already been developed for other viruses, and remdesivir was really the only one that came through. But it is not a home run. It’s a benefit, but it’s not what you really hope to have,” Collins said.
The NIH director said he’s hoping there will be some additional funding, particularly under supplemental virus relief packages. “I think already the Biden administration sees some wisdom in that.”
While the pandemic has been the top priority, Collins mentioned a number of other research areas he wants to advance as part of the $42.9 billion agency he oversees. Those include major ongoing projects to understand how the brain works, and develop targeted treatments known as precision medicine. He also wants to ramp up cancer immunotherapy, gene therapy, and research in Alzheimer’s disease, the opioid crisis and the long-term effects of Covid-19.
“That’s just a short list,” he said. “I could go on a long time about all the things in there that we really want to get fully empowered again.”